Potentially successful alternative strategies and proactive
measures avoiding school closure are available both at general
population level and within schools.
Although high-quality evidence is still lacking to confirm no benefit in
pandemic control in countries that relied the most on school closure and
reciprocally no negative impact from minimizing school closures, reports
found in the grey literature, in particular by the ECDC, do imply such a
trend. The modelled protective potential of school closures [45]
appears to be comparable to that of other non-pharmaceutical
interventions (NPI), such as bans on mass gatherings or closure of
non-essential businesses, implying that widespread school closures could
be circumvented through ready employment of alternative strategies,
while still achieving minimized Sars-CoV-2 spread. This was exemplified
in real-life by the minimal and only temporary closures of Taiwanese
schools throughout 2020 [46]. Furthermore, as synthesized in a large
systematic review [47], multiple organizational, environmental and
surveillance measures have been implemented heterogeneously worldwide to
minimize the risk of in-class infection, including highly effective
test-and-trace strategies, decreased class size, opening for specific
cohorts in a staggered timetable, lessons held outdoors, physical
distancing as well as hygiene measures in the classroom, the creation of
social bubbles limiting contacts between those who rarely meet, and the
instruction to stay at home when sick [48-50]. Although successfully
curtailed school-related outbreaks are less likely to be reported in the
literature than outbreaks that have occurred, we have sufficient
real-world evidence indicating that different types of infection control
measures may effectively either avert or minimalize COVID-19 clusters
among students [51-54]. While the efficacy of each measure has been
extensively modelled, very few experimental and quasi-experimental
studies have been published assessing the effectiveness of specific
measures, including one finding that lower physical distancing policies
may safely be adopted in school settings [55]. A larger pool for
evidence extrapolation is now needed to better tailor guidelines for
safe school re-opening. Acquiring this data would provide critical
knowledge for all future cost-effective policymaking minimizing
educational losses even at times of high-intensity coronavirus spread in
the community.